Factors influencing choice of health system access level in China: A systematic review

Liu, Yun; Kong, Qingxia; Yuan, Shasha; Klundert, Joris van de

doi:10.1371/journal.pone.0201887

Cited by 66 publications

(79 citation statements)

References 53 publications

(38 reference statements)

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“…The current healthcare services in China still rely on hospital care, and PCIs do not play an important role in providing the basic healthcare with the first level of contact. Patients prefer to seek care in higher level of hospitals instead of primary healthcare (PHC) providers due to various factors, such as equipment and drug availability, medical staff, and perceived quality of primary care 74 75. The overdependence on hospital care not only leads to heavy financial burden and barriers to accessing basic healthcare, but also makes it difficult to form effective and continuous management of chronic diseases.…”

Section: Challenges and Policy Recommendationsmentioning

confidence: 99%

Towards universal health coverage: achievements and challenges of 10 years of healthcare reform in China

et al. 2020

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Universal health coverage (UHC) has been identified as a priority for the global health agenda. In 2009, the Chinese government launched a new round of healthcare reform towards UHC, aiming to provide universal coverage of basic healthcare by the end of 2020. We conducted a secondary data analysis and combined it with a literature review, analysing the overview of UHC in China with regard to financial protection, coverage of health services and the reported coverage of the WHO and the World Bank UHC indicators. The results include the following: out-of-pocket expenditures as a percentage of current health expenditures in China have dropped dramatically from 60.13% in 2000 to 35.91% in 2016; the health insurance coverage of the total population jumped from 22.1% in 2003 to 95.1% in 2013; the average life expectancy increased from 72.0 to 76.4, maternal mortality dropped from 59 to 29 per 100 000 live births, the under-5 mortality rate dropped from 36.8 to 9.3 per 1000 live births, and neonatal mortality dropped from 21.4 to 4.7 per 1000 live births between 2000 and 2017; and so on. Our findings show that while China appears to be well on the path to UHC, there are identifiable gaps in service quality and a requirement for ongoing strengthening of financial protections. Some of the key challenges remain to be faced, such as the fragmented and inequitable health delivery system, and the increasing demand for high-quality and value-based service delivery. Given that China has committed to achieving UHC and ‘Healthy China 2030’, the evidence from this study can be suggestive of furthering on in the UHC journey and taking the policy steps necessary to secure change.

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Section: Challenges and Policy Recommendationsmentioning

confidence: 99%

Towards universal health coverage: achievements and challenges of 10 years of healthcare reform in China

et al. 2020

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“…A systematic review of recent empirical research in China to elicit evidence on the determinants of facility level choice identifies four categories of factors influencing choice: patient, provider, context and composite factors. 21 Whether a patient is classified as ‘rural’ (as opposed to ‘urban’) is an example of a patient factor, while travel distance from the patient home to the facility is an example of a composite factor (composed of patient attribute home location and provider attribute facility location).…”

Section: Introductionmentioning

confidence: 99%

“…While there is considerable Chinese evidence to support determinant models, 21–24 there is little evidence on the choice process. Hence, it appears unknown whether patients consider factors simultaneously and weigh them against each other, or alternatively whether (partial) orders exist in which the factors are considered.…”

Section: Introductionmentioning

confidence: 99%

Why patients prefer high-level healthcare facilities: a qualitative study using focus groups in rural and urban China

et al. 2018

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IntroductionDespite policy measure to strengthen and promote primary care, Chinese patients increasingly choose to access higher level hospitals. The resulting overcrowding at higher level hospitals and underutilisation of primary care are viewed to diminish the effects of the continuing health system investments on population health. We explore the factors that influence the choice of healthcare facility level in rural and urban China and aim to reveal the underlying choice processes.MethodsWe conducted eight semistructured focus group discussions among the general population and the chronically ill in a rural area in Chongqing and an urban area in Shanghai. Respondents’ discussions of (evidence-based) factors and how they influenced their facility choices were analysed using qualitative analysis techniques, from which we elicited choice process maps to capture the partial order in which the factors were considered in the choice process.ResultsThe factors considered, after initial illness perception, varied over four stages of health service utilisation: initial visit, diagnosis, treatment and treatment continuation. The factors considered per stage differed considerably between the rural and urban respondents, but less so between the general population and the chronically ill. Moreover, the rural respondents considered the township health centres as default and prefer to continue in primary care, yet access higher levels when necessary. Urban respondents chose higher levels by default and seldom moved down to primary care.ConclusionsDisease severity, medical staff, transportation convenience, equipment and drug availability played important roles when choosing healthcare facilities in China. Strengthening primary care correspondingly may well be effective to increase primary care utilisation by the rural population but insufficient for the urban population. The developed four-stage process maps are general enough to serve as the basis for (partially) ordering factors influencing facility level choices in other contexts.

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“…While universal coverage of basic social health insurance schemes has been achieved and affordability of healthcare services has improved, there has been a growing concern among the Chinese patients about the clinical, interpersonal and amenities aspects of their healthcare experience 12 Reportedly, the doctor–patient relationship had been worsening, and the incidence of violence against healthcare providers had been on the rise in China in recent years 3.…”

Section: Introductionmentioning

confidence: 99%

Patient experience of hospital care in China: major findings from the Chinese Patient Experience Questionnaire Survey (2016–2018)

Chen

Liu

et al. 2019

BMJ Open

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ObjectivesChina launched the National Healthcare Improvement Initiative (NHII) in 2015 to improve patient experiences in healthcare. This study aimed to generate evidence of hospital care quality from the patients’ perspective.DesignThis nationwide cross-sectional study interviewed participants from 31 provinces, municipalities and autonomous regions across China.SettingA total of 117 tertiary hospitals in mainland China.Participants48 422 responses from outpatients and 35 957 responses from inpatients were included in this study.Primary outcome measureThe scores of six predefined domains in the Chinese Patient Experience Questionnaire, five of which were designed to reflect specific dimensions of care, and one of which indicated the overall rating.ResultsMore than 80% of the respondents viewed their care experiences as positive. The NHII seems to have had a positive impact, as indicated by the steady, although unremarkable, increase in the patient experience scores over the 2016–2018 period. The Chinese patients generally reported a positive experience with the clinical aspects of care, but reported a less positive experience with the environmental, interpersonal and social services aspects of care. The institutional factors, including region and type of hospital, and personal factors, such as gender, age, education and occupation, were factors affecting the patient experience in China. Humanistic care was the aspect of care with the greatest association with the overall patient experience rating in both the outpatient and inpatient settings.ConclusionsThe national survey indicated an overall positive patient perspective of care in China. Older age, higher education level and formal employment status were found to be correlated with positive care experiences, as were higher levels of economic development of the region, a more generous insurance benefits package and a higher degree of coordinated care. The interpersonal-related initiatives had substantial roles in the improvement of the patient experience. In the regions where farmers and users of traditional Chinese medicine services constitute a greater proportion of the population, improvement of patient experiences for these groups deserves special policy attention.

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Factors influencing choice of health system access level in China: A systematic review

Cited by 66 publications

References 53 publications

Towards universal health coverage: achievements and challenges of 10 years of healthcare reform in China

Towards universal health coverage: achievements and challenges of 10 years of healthcare reform in China

Why patients prefer high-level healthcare facilities: a qualitative study using focus groups in rural and urban China

Patient experience of hospital care in China: major findings from the Chinese Patient Experience Questionnaire Survey (2016–2018)

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